Healthcare Provider Details

I. General information

NPI: 1225757354
Provider Name (Legal Business Name): MS. SHAMARI EADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAMARI DAJA EADY

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18490 JOHNSON ST UNIT EFGH
PEMBROKE PINES FL
33029-3699
US

IV. Provider business mailing address

18490 JOHNSON ST UNIT EFGH
PEMBROKE PINES FL
33029-3699
US

V. Phone/Fax

Practice location:
  • Phone: 754-264-8779
  • Fax:
Mailing address:
  • Phone: 754-264-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: